1. Field of the Disclosure
The present disclosure is generally directed to surgical instruments and method, and more particularly to a surgical instrument and method of tissue resection and dissection.
2. Description of Related Art
Surgeons often perform procedures where bodily structures must be separated from surrounding tissue. Some of these structures are relatively thin, elongate structures such as tendons, veins, nerves, arteries, and the like. Separation at the juncture between the structure and the adjacent tissue is often desirable, but can very often be somewhat technically difficult and time consuming.
For example, urothelial carcinoma of the upper urinary tract is more commonly known simply as cancer of the kidney lining or of the ureter, which is the tube that drains the kidney to the bladder. This type of cancer accounts for about 4.5 to about 9% of all renal tumors and about 5 to 6% of all urothelial tumors. The traditional or standard treatment for this type of cancer is nephroureterectomy. The procedure essentially involves removal of the kidney and ureter along with excision of the distal ureter from the bladder, along with the small surrounding bladder material or bladder cusp removed with the ureter's opening in the bladder.
Laparoscopy, which involves operating through small ports or incisions and use of cameras, has been applied increasingly in many. of these types of procedures, including nephroureterectomy. As urological surgeons become more comfortable with hand-assisted laparoscopy (laparoscopic surgery in which one hand is inserted through a hand assist port to aid with the surgery), minimally invasive approaches to nephroureterectomy or treatment of this type of cancer have become more commonly employed. However, it remains difficult to manage dissection of the distal ureter or bladder cusp even with these more advanced techniques. This step is the most difficult and time-consuming task during laparoscopic urothelial procedure. Also, other difficulties can arise during resection of the distal ureter, such as extravasation of bladder irrigation, i.e., urine leakage to surrounding tissues. This may lead to hyponatremia, a low sodium condition, or hypervolumeia, a fluid overload condition.
A number of existing options are known for managing the distal ureter during surgery, whether using laparoscopic procedures or not. One option is a complete open bladder cuff removal, which is time consuming and requires a large incision and opening of the bladder. Another option is transurethral resection with a Collin's knife, which requires operating up through the urethra tube leading to the bladder. Transurethral resection is also relatively time consuming and requires repositioning of the patient during the procedure. Another option is transvesical port replacement and resection using a Collin's knife, which requires placing a working or laparoscopic port directly into the bladder. Transvesical port replacement is less time consuming but can be technically very difficult to perform. Another option is stapling of the distal ureter, which poses some degree of risk of cancer recurrence in the intramural ureter left behind in the patient. Each of the above optional procedures is routinely practiced and all result in extravasation of urine into the surrounding area. However, they are all accepted options and provide optimal oncological outcomes, which is to ultimately eliminate the existing cancerous tissue.